Edwin Haywood Shuck III, MD

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

11816 Issued in TN

Practice address

2341 McCallie Ave
Plaza 3 Suite 305
Chattanooga, TN 37404-3239

Phone

(423) 622-2721

NPI assigned

May 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265155200000",
    "number": "1912957739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 FRONTIER BLUFF RD",
            "city": "LOOKOUT MOUNTAIN",
            "state": "GA",
            "postal_code": "307504160",
            "telephone_number": "706-820-0519",
            "fax_number": "706-820-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 MCCALLIE AVE",
            "address_2": "PLAZA 3 SUITE 305",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374043239",
            "telephone_number": "423-622-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUCK",
        "first_name": "EDWIN",
        "middle_name": "HAYWOOD",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2010-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "TN",
            "license": "11816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "020051840",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "0053980",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Daxia Genee Shultz
• Sarah Alexandria Shultz, FNP-C

• Colon & Rectal Surgery Physician in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Colon & Rectal Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.